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Apotemnophilia, Acrotomophilia, Body Integrity Dysphoria (BID)
Body Integrity Dysphoria (aka BIID: Body Integrity Identity
Disorder) appears only in the ICD 11. It is the overwhelming desire to be
rendered disabled (usually by amputating a limb) or the extreme discomfiture
with being able-bodied.
Confusingly, it has several diametrically opposed clinical
manifestations, the most prevalent being apotemnophilia (the wish to be
amputated) and acrotomophilia (being sexually aroused exclusively with a
disabled partner, usually an amputee).
Acrotomphiles enjoy dominating the amputee partner during sex
and are stimulated by the need to position her and take care of her needs.
BID should not be confused with somatoparaphrenia
(“transabled”: denying ownership of a limb – usually the left arm - or of an entire
half of the body, typically the left one, in the face of evidence to the
contrary) or with asomatognosia (loss of recognition of one’s limbs and
mistaking them for other people’s, reversed upon confronting proof of body
In general, single leg amputations with a stump are preferred
to any other intervention, to bilateral disability, or to deafness and
Otherwise “(d)evotees adhere to standard conceptions of
attractiveness in all other matters outside of amputations”(Solvang, 2007).
BID patients present with a mismatch between the mental map
of the body and its actual layout (possibly an error in proprioception or
kinaesthesia mediated via damage to specific proprioceptors, mechanosensory
neurones, or owing to problems with the vestibular system).
Sufferers of BID seek to remedy this incongruence by removing
the redundant, colonizing, or alien parts thus restoring a sexually exciting
(autoerotic), aesthetic, perceived wholeness via self-mutilation (the same way
cancer patients resent their tumors and seek to excise them or, maybe, the same
as pregnant women who feel whole only when the baby is expelled from their
bodies in childbirth).
The anger felt towards the superfluous body part gives rise
to sexual excitation (sex involves sublimated aggression in multiple ways). BID may be
reconceived as a body dysmorphia.
BID patients resort to role play (for example: the use of
prostheses or casts) and, in extremely rare cases, self-harm.
The preference for the surgical removal of left-sided organs
indicates damage to the right parietal lobe. The line of desired amputation
remains stable over the life span and skin conductance is markedly different
above and below it.
We can only speculate as to the psychology of BID.
Modifying our bodies in order to attract mates and to keep
them and also to conform to social mores regarding body image is common
practice: makeup, diets, and plastic and cosmetic surgeries are all examples.
So, the aforementioned restoration of a sense of corporeal completeness may be
one important reason.
Controlling a disabled and dependent partner in order to fend
off debilitating abandonment anxiety (akin to the psychodynamic of Borderline
and Dependent Personality Disorders) may be another.
Such etiology may indicate the existence of underlying
narcissism: narcissists psychologically objectify their partners, reduce them
to body parts or fetishes, and seek to disable them mentally and also by
rendering them physically ill.
Pedophilia may be a form of acrotomophilia: children are not
yet fully formed and are socially and functionally “disabled”.
There is also the issue of infantilization (the wish to be
taken care of and to avoid having to grow up to be an adult).
In Acrotomophilia, the reverse dynamic applies: parentifying.
The acrotomphiliac is grandiose (“I can see beyond the body into the soul”) and
acts as a benevolent and caring parent to his disabled or deformed intimate
partner, perhaps in an attempt to re-enact and resolve early childhood
conflicts with caregivers with a hoped-for different outcome.
Finally, the ability and courage to modify the body is an
autoerotic “private ritual of self-ownership and freedom of choice”, a
reassertion of self-control also witnessed in eating disorders.
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